"We don't predict the future . . . we create it." This was the central theme of Dr. Leland Kaiser's keynote address this morning on "Cancer Care in the 21st Century." Describing himself as a "health futurist," Dr. Kaiser, who is both a consultant and a professor of business at the University of Colorado at Denver, urged his audience to see themselves as "architects of the future."

Dr. Kaiser structured his spirited talk around Sufi teaching tales, which fit his emphasis on the need for both physicians and the entire health care industry to change their "mental model." "Too many organizations are backing into their futures," he said, "and I'm sorry to say that some of those are physicians. . . . I want you to see yourselves as architects of the future, as designers of an improved health care system."

While the future is not set, he said, its direction is - and as far as cancer is concerned, the future is bright with possibility, mainly due to the technological advances of this century. Dr. Kaiser predicted that "we will have technologies that can listen to the cells sing . . . and have the ability to hear one cell singing off key and correct it." Thus, cancer care will shift from after-the-fact treatment to extremely early detection and prevention. We will be able to find that single malfunctioning cell, he asserted, and fix it. The role of radiation oncology, he later added, will be to "change quantum fields" to alter out-of-tune cells, instead of killing them as it now does.

Dr. Kaiser asserted that the 21st century will be looked back upon as the "century of design." He foresees a time when we will redesign our gene pool and even the environment itself to essentially "design out" disease as we know it. Mentioning the Human Genome Project, he asserted that health care will come to be about reengineering defective genetics. Genetic screening of every infant will allow us to identify defects that can be fixed with a "genetic vaccine," preventing future disease. "We can use this technology very foolishly or very wisely," he said, "but man for the first time will assume responsibility for its own evolution." Furthermore, he added, we will engage in "habitat redesign," looking critically at the environmental factors that contribute to disease and "designing them out" as well.

Continuing his theme that "the future is about design," Dr. Kaiser urged radiation oncologists and all physicians to realize that they will create the health care system of the 21st century. The best way to accomplish this, he said, is to adopt a new "mental model" - by acknowledging that health care is a business and acting as such, and treating not just the body but all aspects of a patient, including their emotional, spiritual, and mental well-being. It calls for an openness to integrating alternative and Western medicines and offering patients a constellation of services.

Dr. Kaiser emphasized that he would like to see physicians get beyond the "insurance mentality" because that is "not where growth takes place." We live in a country that loves to see corporations like IBM and Microsoft have a good year, he said, but frowns on a hospital that does. But health care is a business that offers a valuable service and should view itself as such. By the year 2010, he predicts, its portion of the GNP will rise from 14% to 28%.

"Medical care, health care will become the biggest business of the future," Dr. Kaiser said. "We have to stop being part of the unconscious conspiracy to do ourselves in."

How can physicians do this? By striving for excellence. By offering unique services or at least the highest quality services, in order to lead people to seek out their hospital or medical center. By providing care for which people are willing to spend their discretionary income, and not always being tied to an insurance model. And by realizing that "the future of medicine is e-commerce."

"Do you realize that there's no such thing as a local service area in a wired world?" Dr. Kaiser asked. "People purchase perceived value," although there must be some correspondence between the reality and the image, he added. With 35% of Internet use happening for health-related purposes, he said, the consumer is truly king. He urged his audience to think about what is happening in their cancer centers and whether their practices are taking these realities into account.

"What does your Web page look like? How have you distinguished yourself in this market, which is now global? Are you attracting international patients?" he asked. And on a smaller scale, Dr. Kaiser asked his audience to think about how they are distinguishing themselves in local markets. "What do you do at your cancer center that the one across town isn't doing? That no one else in the state does?"

Success for the cancer center of the 21st century, he asserted, is dependent upon achieving two stages of excellence: first, "no one across the U.S. or abroad can do what we do better than we can do it," and second, "no one else know how to do it." This requires putting time and money into research and development, as any successful business does. It also requires learning lessons from businesses that have realized the importance of catering to the consumer. A perfect example, Dr. Kaiser said, is Amazon.com, which not only enables consumers to purchase books, but also personalizes the service to their interests through recommendations and reviews. Pharmaceutical companies are now advertising directly to the consumer because they realize that is where the power lies. "If their physician doesn't have the drug they ask for or won't give it, consumers will simply find another physician," he said.

Attending to the needs of the consumer, Dr. Kaiser added, also means adopting a new model of care that goes beyond the physical nature of disease. "In medicine now, we talk about bodies," he said, but the body is only one-fourth of who we are. "We need to pay attention to the other three parts: emotional, mental, and spiritual. Cancer affects all levels of the person."

Thus, he asserted, the future of cancer care depends on acknowledging the need to address these other aspects of care. Often, this will involve looking beyond Western medicine to new techniques from what he calls "alternate realities." "The cancer center of the new millennium," Dr. Kaiser said, "will address all four levels of existence. . . . . Will your cancer center offer the latest medical technology as well as psychotechnology?" he asked. In other words, will it acknowledge the need to treat the mind as well as the body? Will it be open to practices like aromatherapy and energy healing, as well as sacred design and architecture?

Dr. Kaiser left his audience with a reminder of the power they have as the century turns: "We create the future of our business. . . . We can create any future we want. The consumer will support us."